Assuntos
Angiografia , Veias Pulmonares , Estudos de Viabilidade , Humanos , Imageamento TridimensionalRESUMO
Increased catheter-based interventions in congenital and structural heart disease require imaging modalities to be oriented in the same visual perspective. The use of echocardiography-fluoroscopy fusion (EFF) imaging has been developed for better characterization of complex anatomy and to facilitate key steps in interventional procedures. This review will detail the technology behind EFF, the differences between the two ultrasound fusion systems, and essential features of EFF imaging in congenital and structural heart disease interventions.
Assuntos
Cardiopatias Congênitas , Radiografia Intervencionista , Cateterismo Cardíaco , Ecocardiografia , Fluoroscopia , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem Multimodal , Ultrassonografia de IntervençãoRESUMO
With the increasing frequency of catheter-based interventions in congenital heart disease and structural heart disease, the use of fusion imaging has become a major enhancement for understanding complex anatomy and facilitating key steps in interventional procedures. Because transesophageal echocardiography and fluoroscopy are displayed in different visual perspectives, the interventional cardiologist must mentally reregister the images from the two modalities during the procedure. Echocardiography-fluoroscopy fusion (EFF) imaging displays the x-ray and ultrasound overlay images in the same visual perspective. This new technology allows for enhanced team communication, improved visual guidance, and more efficient navigation. The purpose of this review is to describe the EFF imaging technology, current uses of EFF imaging in congenital and structural heart disease, and future directions that will enhance this unique imaging technology to guide interventional procedures.
Assuntos
Ecocardiografia Tridimensional/métodos , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Imagem Multimodal/métodos , Radiografia Intervencionista/métodos , Feminino , Fluoroscopia/métodos , Cardiopatias Congênitas/fisiopatologia , Humanos , Recém-Nascido , Masculino , Sensibilidade e EspecificidadeAssuntos
Falso Aneurisma/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Obstrução do Fluxo Ventricular Externo/etiologia , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Valva Aórtica/cirurgia , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Fluoroscopia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Masculino , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/cirurgiaAssuntos
Cateterismo Cardíaco , Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Cardiopatias Congênitas/terapia , Cardiopatias/terapia , Radiografia Intervencionista , Pontos de Referência Anatômicos , Cateterismo Cardíaco/instrumentação , Fluoroscopia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Humanos , Imagem Multimodal , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Resultado do TratamentoRESUMO
Three-dimensional transesophageal echocardiography (TEE) provides real-time soft tissue information, but its use is hampered by its limited field of view. The mosaicing of multiple TEE views makes it possible to visualize a large structure, like the left atrium, in a single volume. To this end, an automatic registration method is required. Similarly to atlas-based segmentation approaches, atlas-based mosaicing (ABM) uses a full volume atlas set to moderate the onerous registration of the individual TEE views. The performance of ABM depends both on the quality of the involved registrations and on the selection of the optimal transformation from the candidate transformations that result from the various atlases. The study described here explored the performance of different selection strategies on multiview TEE data of the left atrium. We found that by incorporating two stages of transformation selection, using the image similarity and the conformity between the candidate transformations as selection criteria, the average registration error dropped below 3 mm with respect to manual registration of these data. Finally, we used this method for the automatic construction of a wide-view TEE volume of the left atrium.
Assuntos
Fibrilação Atrial/fisiopatologia , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Processamento de Imagem Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico por imagem , Meios de Contraste , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Aumento da Imagem/métodos , Masculino , Pessoa de Meia-Idade , Ácidos Tri-IodobenzoicosRESUMO
Transesophageal echocardiography (TEE) is a promising imaging modality used to guide cardiac interventions, such as catheter ablation for the treatment of cardiac arrhythmias. These procedures rely on good visualization of the left atrium and pulmonary veins. To visualize these structures in a single volume, the acquisition, registration and fusion of multiple TEE views of the left atrium are required. We introduce atlas-based mosaicing as a method for the registration of images that are acquired according to a standardized protocol. Inspired by atlas-based segmentation approaches, compounded data of other patients serve as atlases for the registration of new data. The performance of atlas-based mosaicing is studied on 3-D TEE data of the left atrium and compared with that of regular pairwise registration. This study indicates that improved registration robustness and smaller registration errors are achieved with atlas-based mosaicing compared with regular pairwise registration. This is an important step toward the use of TEE for interventional guidance of ablation procedures.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Átrios do Coração/diagnóstico por imagem , Humanos , Reprodutibilidade dos TestesRESUMO
Three-dimensional transesophageal echocardiography (TEE) is an excellent modality for real-time visualization of the heart and monitoring of interventions. To improve the usability of 3-D TEE for intervention monitoring and catheter guidance, automated segmentation is desired. However, 3-D TEE segmentation is still a challenging task due to the complex anatomy with multiple cavities, the limited TEE field of view, and typical ultrasound artifacts. We propose to segment all cavities within the TEE view with a multi-cavity active shape model (ASM) in conjunction with a tissue/blood classification based on a gamma mixture model (GMM). 3-D TEE image data of twenty patients were acquired with a Philips X7-2t matrix TEE probe. Tissue probability maps were estimated by a two-class (blood/tissue) GMM. A statistical shape model containing the left ventricle, right ventricle, left atrium, right atrium, and aorta was derived from computed tomography angiography (CTA) segmentations by principal component analysis. ASMs of the whole heart and individual cavities were generated and consecutively fitted to tissue probability maps. First, an average whole-heart model was aligned with the 3-D TEE based on three manually indicated anatomical landmarks. Second, pose and shape of the whole-heart ASM were fitted by a weighted update scheme excluding parts outside of the image sector. Third, pose and shape of ASM for individual heart cavities were initialized by the previous whole heart ASM and updated in a regularized manner to fit the tissue probability maps. The ASM segmentations were validated against manual outlines by two observers and CTA derived segmentations. Dice coefficients and point-to-surface distances were used to determine segmentation accuracy. ASM segmentations were successful in 19 of 20 cases. The median Dice coefficient for all successful segmentations versus the average observer ranged from 90% to 71% compared with an inter-observer range of 95% to 84%. The agreement against the CTA segmentations was slightly lower with a median Dice coefficient between 85% and 57%. In this work, we successfully showed the accuracy and robustness of the proposed multi-cavity segmentation scheme. This is a promising development for intraoperative procedure guidance, e.g., in cardiac electrophysiology.
Assuntos
Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Processamento de Imagem Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , MasculinoRESUMO
Minimally invasive interventions in the heart such as in electrophysiology are becoming more and more important in clinical practice. Currently, preoperative computed tomography angiography (CTA) is used to provide anatomic information during electrophysiology interventions, but this does not provide real-time feedback and burdens the patient with additional radiation and side effects of the contrast agent. Three-dimensional transesophageal echocardiography (TEE) is an excellent modality for visualization of anatomic structures and instruments in real time, but some cavities, especially the left atrium, suffer from the limited coverage of the 3-D TEE volumes. This leads to difficulty in segmenting the left atrium. We propose replacing or complementing pre-operative CTA imaging with wide-view TEE. We tested this proposal on 20 patients for which TEE image volumes covering the left atrium and CTA images were acquired. The TEE images were manually registered, and wide-view volumes were generated. Five heart cavities in single-view and wide-view TEE were segmented and compared with atlas based-segmentations derived from the CTA images. We found that the segmentation accuracy (Dice coefficients) improved relative to segmentation of single-view images by 5, 15 and 9 percentage points for the left atrium, right atrium and aorta, respectively. Average anatomic coverage was improved by 2, 29, 62 and 49 percentage points for the right ventricle, left atrium, right atrium and aorta, respectively. This finding confirms that wide-view 3-D TEE can be useful in supporting electrophysiology interventions.
Assuntos
Algoritmos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Reconhecimento Automatizado de Padrão/métodos , Idoso de 80 Anos ou mais , Sistemas Computacionais , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Most automated segmentation approaches to the mitral valve and left ventricle in 3-D echocardiography require a manual initialization. In this article, we propose a fully automatic scheme to initialize a multicavity segmentation approach in 3-D transesophageal echocardiography by detecting the left ventricle long axis, the mitral valve and the aortic valve location. Our approach uses a probabilistic and structural tissue classification to find structures such as the mitral and aortic valves; the Hough transform for circles to find the center of the left ventricle; and multidimensional dynamic programming to find the best position for the left ventricle long axis. For accuracy and agreement assessment, the proposed method was evaluated in 19 patients with respect to manual landmarks and as initialization of a multicavity segmentation approach for the left ventricle, the right ventricle, the left atrium, the right atrium and the aorta. The segmentation results revealed no statistically significant differences between manual and automated initialization in a paired t-test (p > 0.05). Additionally, small biases between manual and automated initialization were detected in the Bland-Altman analysis (bias, variance) for the left ventricle (-0.04, 0.10); right ventricle (-0.07, 0.18); left atrium (-0.01, 0.03); right atrium (-0.04, 0.13); and aorta (-0.05, 0.14). These results indicate that the proposed approach provides robust and accurate detection to initialize a multicavity segmentation approach without any user interaction.
Assuntos
Valva Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Ventrículos do Coração/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Valva Mitral/diagnóstico por imagem , Reconhecimento Automatizado de Padrão/métodos , Idoso , Algoritmos , Pontos de Referência Anatômicos/diagnóstico por imagem , Inteligência Artificial , Feminino , Humanos , Aumento da Imagem/métodos , Masculino , Sensibilidade e EspecificidadeRESUMO
PURPOSE: The aim of this paper is to propose a transoesophageal echocardiography (TOE) image acquisition protocol which provides a systematic manner of acquiring a minimal number of overlapping 3D TOE datasets allowing the reconstruction of a wide 3D view of the left atrium (LA) with anatomical landmarks that are important for atrial fibrillation catheter ablation. METHODS: In eight cardiac surgical patients, 3D TOE datasets were acquired with a six-step protocol. In the protocol, step 1 aims to acquire the central view of the mitral valve (MV), aortic valve (AV) and left atrial appendage (LAA). Step 2 was developed to acquire the left pulmonary veins (PVs) and step 3 to acquire the right PVs. Steps 4, 5 and 6 were developed to create a sufficient overlap between different datasets. 3D TOE datasets were registered and fused manually in end diastole. RESULTS: The image acquisition protocol was feasible in all patients. In the fused 3D dataset, a wide 3D view of the LA is shown, and left and right PVs could be seen simultaneously. The LAA, MV, AV and fossa ovalis (FO) were visualised clearly in the 3D TOE datasets. The PV ostia, which are located at the edges of the 3D datasets, suffered more from the artefact of echo loss. The volume overlaps between neighbouring TOE datasets were 50-75 %. CONCLUSION: The major part of the LA anatomy incorporating the PVs, LAA, MV, AV and FO as important anatomical landmarks can be reconstructed by registering and fusing 3D datasets acquired with the six-step TOE image acquisition protocol.
Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Interpretação de Imagem Assistida por Computador/métodos , Técnica de Subtração , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
This contribution demonstrates that quantitative ultrasound (QUS) capabilities are platform independent, using an in vivo model. Frequency-dependent attenuation estimates, backscatter coefficient, and effective scatterer diameter estimates are shown to be comparable across four different ultrasound imaging systems with varied processing techniques. The backscatter coefficient (BSC) is a fundamental material property from which several QUS parameters are estimated; therefore, consistent BSC estimates among different systems must be demonstrated. This study is an intercomparison of BSC estimates acquired by three research groups (UIUC, UW, ISU) from four in vivo spontaneous rat mammary fibroadenomas using three clinical array systems and a single-element laboratory scanner system. Because of their highly variable backscatter properties, fibroadenomas provided an extreme test case for BSC analysis, and the comparison is across systems for each tumor, not across the highly heterogeneous tumors. RF echo data spanning the 1 to 12 MHz frequency range were acquired in three dimensions from all animals using each system. Each research group processed their RF data independently, and the resulting attenuation, BSC, and effective scatterer diameter (ESD) estimates were compared. The attenuation estimates across all systems showed the same trends and consistently fit the power-law dependence on frequency. BSCs varied among the multiple slices of data acquired by each transducer, with variations between transducers being of a similar magnitude as those from slice to slice. Variation between BSC estimates was assessed via functional signal-to-noise ratios derived from backscatter data. These functional signal-to-noise ratios indicated that BSC versus frequency variations between systems ranged from negligible compared with the noise level to roughly twice the noise level. The corresponding functional analysis of variance (fANOVA) indicated statistically significant differences between BSC curves from different systems. However, root mean squared difference errors of the BSC values (in decibels) between different transducers and imaging platforms were less than half of the BSC magnitudes in most cases. Statistical comparison of the effective scatterer diameter (ESD) estimates resulted in no significant differences in estimates from three of the four transducers used for those estimates, demonstrating agreement among estimates based on the BSC. This technical advance demonstrates that these in vivo measurements can be made in a system-independent manner; the necessary step toward clinical implementation of the technology.
Assuntos
Fibroadenoma/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Ultrassonografia/métodos , Animais , Feminino , Fibroadenoma/química , Fibroadenoma/patologia , Imagens de Fantasmas , Ratos , Ratos Sprague-DawleyRESUMO
OBJECTIVES: Ultrasound contrast agents (UCAs) are intravenously infused microbubbles that add definition to ultrasonic images. Ultrasound contrast agents continue to show clinical promise in cardiovascular imaging, but their biological effects are not known with confidence. We used a cholesterol-fed rabbit model to evaluate these effects when used in conjunction with ultrasound (US) to image the descending aorta. METHODS: Male New Zealand White rabbits (n = 41) were weaned onto an atherogenic diet containing 1% cholesterol, 10% fat, and 0.11% magnesium. At 21 days, rabbits were exposed to contrast US at 1 of 4 pressure levels using either the UCA Definity (Lantheus Medical Imaging, Inc, North Billerica, MA) or a saline control (n = 5 per group). Blood samples were collected and analyzed for lipids and von Willebrand factor (vWF), a marker of endothelial function. Animals were euthanized at 42 days, and tissues were collected for histologic analysis. RESULTS: After adjustment for pre-exposure vWF, high-level US (in situ [at the aorta] peak rarefactional pressure of 1.4 or 2.1 MPa) resulted in significantly lower vWF 1 hour post exposure (P = .0127; P(adj) < .0762). This difference disappeared within 24 hours. Atheroma thickness in the descending aorta was lower in animals receiving the UCA compared to animals receiving saline. CONCLUSIONS: Contrast US affected the descending aorta, as evidenced by two separate outcome measures. These results may be a first step in elucidating a previously unknown biological effect of UCAs. Further research is warranted to characterize the effects of this procedure.
Assuntos
Aorta/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Meios de Contraste/farmacologia , Fluorocarbonos/farmacologia , Hipercolesterolemia/diagnóstico por imagem , Fator de von Willebrand/análise , Animais , Modelos Animais de Doenças , Lipídeos/análise , Masculino , Coelhos , Distribuição Aleatória , UltrassonografiaRESUMO
Ultrasonic backscatter is useful for characterizing tissues and several groups have reported methods for estimating backscattering properties. Previous interlaboratory comparisons have been made to test the ability to accurately estimate the backscatter coefficient (BSC) by different laboratories around the world. Results of these comparisons showed variability in BSC estimates but were acquired only for a relatively narrow frequency range, and, most importantly, lacked reference to any independent predictions from scattering theory. The goal of this study was to compare Faran-scattering-theory predictions with cooperatively-measured backscatter coefficients for low-attenuating and tissue-like attenuating phantoms containing glass sphere scatterers of different sizes for which BSCs can independently be predicted. Ultrasonic backscatter measurementswere made for frequencies from 1 to 12 MHz. Backscatter coefficients were estimated using two different planar-reflector techniques at two laboratories for two groups of phantoms. Excellent agreement was observed between BSC estimates from both laboratories. In addition, good agreement with the predictions of Faran's theory was obtained, with average fractional (bias) errors ranging from 8-14%. This interlaboratory comparison demonstrates the ability to accurately estimate parameters derived from the BSC, including an effective scatterer size and the acoustic concentration, both of which may prove useful for diagnostic applications of ultrasound tissue characterization.
Assuntos
Ultrassom , Ultrassonografia/normas , Animais , Desenho de Equipamento , Gelatina , Vidro , Leite , Imagens de Fantasmas , Processamento de Sinais Assistido por Computador , Transdutores , ÁguaRESUMO
Applicability of ultrasound phantoms to biological tissue has been limited because most phantoms have generally used strong scatterers. The objective was to develop very weakly scattering phantoms, whose acoustic scattering properties are likely closer to those of tissues and then compare theoretical simulations and experimental backscatter coefficient (BSC) results. The phantoms consisted of agar spheres of various diameters (nominally between 90 and 212 microm), containing ultrafiltered milk, suspended in an agar background. BSC estimates were performed at two institutions over the frequency range 1-13 MHz, and compared to three models. Excellent agreement was shown between the two laboratory results as well as with the three models.
Assuntos
Ágar , Imagens de Fantasmas , Espalhamento de Radiação , Ultrassonografia/instrumentação , Animais , Microesferas , Leite , Modelos Teóricos , Variações Dependentes do Observador , Tamanho da Partícula , Reprodutibilidade dos Testes , UltrafiltraçãoRESUMO
OBJECTIVE: To translate quantitative ultrasound (QUS) from the laboratory into the clinic, it is necessary to demonstrate that the measurements are platform independent. Because the backscatter coefficient (BSC) is the fundamental estimate from which additional QUS estimates are calculated, agreement between BSC results using different systems must be demonstrated. This study was an intercomparison of BSCs from in vivo spontaneous rat mammary tumors acquired by different groups using 3 clinical array systems and a single-element laboratory scanner system. METHODS: Radio frequency data spanning the 1- to 14-MHz frequency range were acquired in 3 dimensions from all animals using each system. Each group processed their radio frequency data independently, and the resulting BSCs were compared. The rat tumors were diagnosed as either carcinoma or fibroadenoma. RESULTS: Carcinoma BSC results exhibited small variations between the multiple slices acquired with each transducer, with similar slopes of BSC versus frequency for all systems. Somewhat larger variations were observed in fibroadenomas, although BSC variations between slices of the same tumor were of comparable magnitude to variations between transducers and systems. The root mean squared (RMS) errors between different transducers and imaging platforms were highly variable. The lowest RMS errors were observed for the fibroadenomas between 4 and 5 MHz, with an average RMS error of 4 x 10(-5) cm(-1)Sr(-1) and an average BSC value of 7.1 x 10(-4) cm(-1)Sr(-1), or approximately 5% error. The highest errors were observed for the carcinoma between 7 and 8 MHz, with an RMS error of 1.1 x 10(-1) cm(-1)Sr(-1) and an average BSC value of 3.5 x 10(-2) cm(-1)Sr(-1), or approximately 300% error. CONCLUSIONS: This technical advance shows the potential for QUS technology to function with different imaging platforms.
Assuntos
Neoplasias/diagnóstico por imagem , Transdutores , Animais , Ratos , Ratos Sprague-Dawley , Ultrassonografia/instrumentaçãoRESUMO
This work presents experimental responses of single ultrasound contrast agents to short, large amplitude pulses, characterized using double passive cavitation detection. In this technique, two matched, focused receive transducers were aligned orthogonally to capture the acoustic response of a microbubble from within the overlapping confocal region. The microbubbles were categorized according to a classification scheme based on the presence or absence of postexcitation signals, which are secondary broadband spikes following the principle oscillatory response of the ultrasound contrast agent and are indicative of the transient collapse of the microbubble. Experiments were conducted varying insonifying frequencies (0.9, 2.8, 4.6, and 7.1 MHz) and peak rarefactional pressures (200 kPa to 6.2 MPa) for two types of contrast agents (Definity and Optison). Results were fit using logistic regression analysis to define pressure thresholds where at least 5% and 50% of the microbubble populations collapsed for each frequency. These thresholds were found to occur at lower pressures for Definity than for Optison over the range of frequencies studied; additionally, the thresholds occurred at lower pressures with lower frequencies for both microbubble types in most cases, though this trend did not follow a mechanical index scaling.